Multiple things going on at the same time: determinants of appropriate primary diabetic eyecare delivery.

PURPOSE: A recent nationwide medical record audit of optometry practices has identified an evidence-to-practice gap in primary diabetic eyecare delivery. This study aimed to explore the determinants (barriers and enablers) to appropriate diabetic eyecare delivery in Australia. METHODS: A qualitative study involving focus-group discussions and interviews of a purposeful sample of Australian optometrists was conducted. Participants were asked about the perceived barriers to adherence to four underperforming clinical indicators related to primary diabetic eyecare identified by the recent national optometry practice audit. The Theoretical Domain Framework was used for thematic analysis and coding salience to identify key behavioural determinants. RESULTS: Optometrists participated in eight focus groups (n = 27) and individual interviews (n = 4). The most salient barriers were related to Environmental resources (e.g., limited chair time); Beliefs about consequences (e.g., lack of perceived importance); Knowledge (e.g., poor understanding); Professional role/identity (e.g., the perceived role of optometry in care process); Social influences (e.g., the influence of senior optometrists) and Intentions (e.g., apathy). Key enablers were Environmental resources (e.g., electronic record system and practice aids); Knowledge (e.g., keeping up with knowledge/professional development); reinforcements (e.g., fear of legal actions) and behavioural regulations (e.g., self-monitoring/audit). CONCLUSIONS: This study shows that the evidence-to-practice gap in primary diabetic eyecare delivery in Australia can be attributed in part to several interconnected factors related to optometrists' individual capability and motivation as well as the social and practice environment within which they sit. These behavioural determinants will inform the design of an intervention to improve the appropriateness of primary diabetic eyecare delivery.

Healthcare costs following falls and cataract surgery in older adults using Australian linked health data from 2012-2019.

OBJECTIVES: To investigate publicly funded healthcare costs according to faller status and the periods pre- and post-cataract surgeries, and identify factors associated with higher monthly costs in older people with bilateral cataract. METHODS: This prospective cohort study included community-dwelling older people aged 65 and over (between 2012 and 2019); at baseline participants had bilateral cataract and were waiting for cataract surgery in New South Wales (NSW) public hospitals. Participants were followed for 24 months. The study used self-reported and linked data (Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, NSW Admitted Patient and Emergency Department Data Collections) to identify falls, cataract surgeries and healthcare costs incurred by the Australian and NSW Governments, all costs were inflated to 2018-19 Australian dollars (AUD). Median monthly healthcare costs were calculated for faller status (non-faller, non-medically treated faller, medically treated faller) and surgery periods (pre-surgery, post-first surgery, post-second surgery). Costs in the 30 days following a medically treated fall were estimated. A generalised linear model was used to investigate predictors of healthcare costs. RESULTS: During the median follow-up period of 24 months, 274 participants suffered 448 falls, with 95 falls requiring medical treatment. For medically treated falls, the mean cost in the 30 days after treatment was A$3779 (95% confidence interval $2485, $5074). Higher monthly healthcare costs were associated with a higher number of medications, being of the male sex, having one or more medically treated falls and having bilateral cataract surgery. After excluding the cost of cataract surgery, there were no significant differences in healthcare costs between the pre-cataract surgery, post-first eye cataract surgery and post-second eye cataract surgery periods. CONCLUSIONS: To our knowledge, this is the first study investigating publicly funded costs related to falls and cataract surgery in older people with bilateral cataract. This information enhances our understanding of healthcare costs in this group. The patterns in costs associated with falls can guide future government healthcare expenditure on falls treatment and prevention, including timely cataract surgery.